摘要
目的观察绝经后女性类风湿关节炎(RA)患者前臂骨密度(BMD)的变化,探讨前臂BMD对骨质疏松的诊断价值。方法选取绝经后女性RA患者193例,双能X线吸收法(DXA)测量非受力(左)侧前臂远端1/3处BMD,并测量中轴部分[正位腰椎(L2～4段)及左髋部]BMD。根据中轴部位BMD值,将RA患者分为正常及异常者,比较不同患者前臂BMD、骨矿含量及T值。采用ROC曲线分析前臂BMD对不同部位骨质疏松的预测价值。结果中轴BMD值异常164例,其中骨量减少71例,骨质疏松74例,严重骨质疏松19例;中轴BMD值正常仅29例。前臂BMD值异常146例,其中骨量减少60例,骨质疏松67例,严重骨质疏松19例;前臂BMD值正常47例。中轴BMD正常者年龄明显小于异常者,前臂BMD、骨矿含量及T值均明显优于异常者,差异均有统计学意义(均P<0.01)。腰椎、左髋部BMD正常者年龄均明显小于异常者,前臂BMD、骨矿含量及T值均明显优于异常者,差异均有统计学意义(均P<0.01)。ROC曲线显示:前臂BMD诊断腰椎骨质疏松的AUC为0.932,最佳T值为0.355,灵敏度为0.814,特异度为0.951;前臂BMD诊断左髋部骨质疏松的AUC为0.955,最佳T值为0.365,灵敏度为0.776,特异度为0.973。结论前臂BMD对腰椎、左髋部骨质疏松的诊断准确性较高,可作为诊断绝经后女性RA患者椎体、髋部骨质疏松的辅助工具。
Objective To assess the value of forearm bone mineral density（BMD） for diagnosis of osteoporosis in postmenopausal women with rheumatoid arthritis（RA）. Methods One hundred and ninety three female RA patients were enrolled in the study. BMD of lumbar vertebrae, left hip and distal forearm were measured by dual energy X-ray （DXA）. With BMD value of the central axis as gold standard the ROC curve was used to analyze the diagnostic value of forearm BMD for osteoporosis in RA patients. Results There were 164 cases of abnormal BMD in the central axis, including 71 cases of bone loss, 74 cases of osteoporosis, 19 cases of severe osteoporosis. There were 146 cases of abnormal BMD in the forearm, including 60 cases of bone loss, 67 cases of osteoporosis, 19 cases of severe osteoporosis. The age of patients with normal BMD in central axis was significantly lower than that of abnormal BMD patients （P〈0.01）. The BMD, bone mineral content and T value of the forearm in normal patients were significantly better than those in abnormal patients （all P〈0.01）. The BMD, bone mineral content and T value in the forearm of patients with normal BMD in the lumbar spine and left hip were significantly better than those in the abnormal ones（all P〈0.01）. The ROC curve showed that the forearm BMD in diagnosis of lumbar osteoporosis had an AUC of 0.932, and the best T value was 0.355, the sensitivity was 0.814, and the specificity was 0.951. The forearm BMD in diagnosis of the left hip osteoporosis had an AUC of 0.955, and the T value was 0.365, the sensitivity was 0.776, and the specificity was 0.973. Conclusion The forearm BMD has high diagnostic accuracy for lumbar and left hip osteoporosis, and can be used as an auxiliary tool for diagnosing vertebral and hip osteoporosis in postmenopausal women with RA.
作者
陈杨畅
李素蘋
项光博
金珍木
CHEN Yangchang;LI Supin;XIANG Guangbo(Department of Rrheumatology,Wenzhou Central Hospital,Wenzhou 325000,China)
出处
《浙江医学》
CAS
2018年第22期2466-2469,共4页
Zhejiang Medical Journal
关键词
类风湿关节炎
前臂骨密度扫描
绝经后女性
分布规律
骨质疏松
Rheumatoid arthritis
Forearm bone mineral density scanning
Postmenopausal women
Distribution Osteoporosis
